自体角膜为载体Boston人工角膜治疗复杂性角膜盲

摘要

目的 评价复杂性角膜混浊患者使用自体角膜做载体的Boston Ⅰ型人工角膜植入的临床效果.方法 回顾性病例研究.10例角膜盲患者(10眼),术眼病变严重,经至少2名以上国内著名角膜病专家会诊,无法通过角膜移植复明.其中严重碱烧伤7眼,爆炸伤1眼,角膜内皮失代偿多次角膜移植失败1眼,双眼病毒性角膜炎角膜严重血管化1眼.其中9例为双眼盲.术前视力光感或手动.所有病例均一期完成手术,术中使用8.0 mm或8.5 mm环钻钻取患者角膜,用患者混浊病变的角膜为载体,安装Boston人工角膜.形成患者角膜-人工角膜复合体,复合体作为植片如传统角膜移植实行角膜植床和植片缝合固定,术中常规行晶状体摘除术.结果 术后观察1～ 12个月,平均(5.7±3.8)个月,除1眼视力光感外,其余裸眼视力为0.1～0.8.手术并发症包括角膜植床出血入玻璃体腔2例,继发性青光眼2例,人工角膜后膜4例.所有术眼均无术后漏水并发症发生.结论 人工角膜特别适合于穿透性角膜移植难于成功的角膜盲患者,而且是目前对严重角膜瘢痕血管化、眼睑或泪液功能不良患者有效的复明手段.我国角膜供体严重匮乏,用自体角膜为载体可作为部分Boston Ⅰ型人工角膜植入手术的可行方案.%Objective The purpose of this study was to investigate the possibility for autologous corneas as a carrier for the Boston Keratoprosthesis.Methods It was a retrospective case series study.Ten eyes (10 patients) with severe cornea neovascularization that underwent Boston KPro type Ⅰ implantation at the PLA General Hospital.Of these 10 eyes,7 had severe chemical burns, 1 had an explosion injury, 1 experienced a multiple penetrate keratoplasty failure, and 1 had a severe neovascularization cornea from herpes simplex keratitis (HSK).Patients were not appropriate candidates for anterior lamellar keratoplasty due to severely scarred eyelids or full-thickness central corneal scars.All patients received an aphakic KPro with a polymethyl methacrylate backplate and a titanium locking ring assembled around an 8.0-8.5 mm trephinated ipsilateral autologous cornea. An extracapsular cataract extraction was performed on all patients through the corneal trephination opening.Postoperative data from 1-12 months were reported,including compliance,visual outcomes and complications. Results Patients were followup for 5.7 ± 3.8 months. Preoperative visual acuity ranged from counting fingers to light perception. Best corrected postoperative visual acuity ranged from 160/200 to light perception.Anatomic success was achieved in all eyes. Conclusion Autologous corneas as a carrier for the Boston Keratoprosthesis may be a solution for the shortage of donor cornea.